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      Verification of dynamic and segmental IMRT delivery by dynamic log file analysis

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          Abstract

          A program has been developed to evaluate the delivered fluence of step‐and‐shoot segmental and sliding window dynamic multileaf collimator (MLC) fields. To automate these checks, a number of tools have been developed using data available from the dynamic log files that can be created each time a dynamic delivery occurs. Experiments were performed with a Varian 2100EX with a 120 leaf MLC equipped with dynamic capabilities. A dynamic leaf sequence is delivered and measured with film or an amorphous silicon imager. After delivery, the dynamic log file is written by the accelerator control system. The file reports the expected and actual position for each leaf and the dose fraction every 0.055 seconds. Leaf trajectories are calculated from this data and expected and actual fluence images are created from the difference of opposing leaf trajectories. These images can be compared with the expected delivery, measurements, and calculations of fluence. Tools have been developed to investigate other aspects of the delivery, such as specific leaf errors, beam hold‐off flags sent by the control system to the MLC, and gap widths. This program is part of a semi‐automated quality assurance (QA) system for pretreatment fluence verification and daily treatment verification of dynamic multileaf collimation (DMLC) delivery.

          PACS number(s): 87.53.–j, 87.52.–g

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          Physical and dosimetric aspects of a multileaf collimation system used in the dynamic mode for implementing intensity modulated radiotherapy.

          The use of a multileaf collimator in the dynamic mode to perform intensity modulated radiotherapy became a reality at our institution in 1995. Unlike treatment with static fields using a multileaf collimator, there are significant dosimetric issues which must be assessed before dynamic therapy can be implemented. We have performed a series of calculations and measurements to quantify head scatter for small fields, collimator transmission, and the transmission through rounded leaf ends. If not accounted for, these factors affect the delivered dose to the prostate by 5%-20% for a typical plan. Data obtained with ion chambers and radiographic film are presented for both 6 and 15 MV x-ray beams. The impact on the delivered dose of the mechanical accuracy of the multileaf collimator, achieved during leaf position calibration and maintained during dose delivery, is also discussed.
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            Comprehensive quality assurance for the delivery of intensity modulated radiotherapy with a multileaf collimator used in the dynamic mode.

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              Planning, delivery, and quality assurance of intensity-modulated radiotherapy using dynamic multileaf collimator: a strategy for large-scale implementation for the treatment of carcinoma of the prostate.

              To improve the local control of patients with adenocarcinoma of the prostate we have implemented intensity modulated radiation therapy (IMRT) to deliver a prescribed dose of 81 Gy. This method is based on inverse planning and the use of dynamic multileaf collimators (DMLC). Because IMRT is a new modality, a major emphasis was on the quality assurance of each component of the process and on patient safety. In this article we describe in detail our procedures and quality assurance program. Using an inverse algorithm, we have developed a treatment plan consisting five intensity-modulated (IM) photon fields that are delivered with DMLC. In the planning stage, the planner specifies the number of beams and their directions, and the desired doses for the target, the normal organs and the "overlap" regions. Then, the inverse algorithm designs intensity profiles that best meet the specified criteria. A second algorithm determines the leaf motion that would produce the designed intensity pattern and produces a DMLC file as input to the MLC control computer. Our quality assurance program for the planning and treatment delivery process includes the following components: 1) verification of the DMLC field boundary on localization port film, 2) verification that the leaf motion of the DMLC file produces the planned dose distribution (with an independent calculation), 3) comparison of dose distribution produced by DMLC in a flat phantom with that calculated by the treatment planning computer for the same experimental condition, 4) comparison of the planned leaf motions with that implemented for the treatment (as recorded on the MLC log files), 5) confirmation of the initial and final positions of the MLC for each field by a record-and-verify system, and 6) in vivo dose measurements. Using a five-field IMRT plan we have customized dose distribution to conform to and deliver 81 Gy to the PTV. In addition, in the overlap regions between the PTV and the rectum, and between the PTV and the bladder, the dose is kept within the tolerance of the respective organs. Our QA checks show acceptable agreement between the planned and the implemented leaf motions. Correspondingly, film and TLD dosimetry indicates that doses delivered agrees with the planned dose to within 2%. As of September 15, 1996, we have treated eight patients to 81 Gy with IMRT. For complex planning problems where the surrounding normal tissues place severe constraints on the prescription dose, IMRT provides a powerful and efficient solution. Given a comprehensive and rigorous quality-assurance program, the intensity-modulated fields can be efficaciously and accurately delivered using DMLC. IMRT treatment is now ready for routine implementation on a large scale in our clinic.
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                Author and article information

                Contributors
                litzen@umich.edu
                jmmoran@umich.edu
                bfraass@umich.edu
                Journal
                J Appl Clin Med Phys
                J Appl Clin Med Phys
                10.1002/(ISSN)1526-9914
                ACM2
                Journal of Applied Clinical Medical Physics
                John Wiley and Sons Inc. (Hoboken )
                1526-9914
                01 March 2002
                Spring 2002
                : 3
                : 2 ( doiID: 10.1002/acm2.2002.3.issue-2 )
                : 63-72
                Affiliations
                [ 1 ] Department of Radiation Oncology University of Michigan Medical Center 1500 East Medical Center Drive Ann Arbor Michigan 48109‐0010
                Article
                ACM20063
                10.1120/jacmp.v3i2.2578
                5724614
                11958647
                35a25bbf-7eb9-4081-a3ea-cf1b44155b7f
                © 2002 The Authors.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 October 2001
                : 17 December 2001
                Page count
                Figures: 6, Tables: 2, References: 14, Pages: 10, Words: 4082
                Funding
                Funded by: NIH
                Award ID: P01‐CA59827
                Categories
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                2.0
                acm20063
                Spring 2002
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.5 mode:remove_FC converted:16.11.2017

                imrt,quality assurance,sequence verification,dynamic log file

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